What are you carrying during clinical year

[xxx]

I am about a month away from starting my clinical year and would like some opinions on what references you are carrying and in what format. I am trying to decide between getting an ipad mini, iphone 6 plus or maybe just a few books.  I tried searching the forum but didn’t find too many threads. Looking for a system to get me through my clinical year and a residency.  If your using digital what apps and e-books do you carry or if your old schools what books are you carrying?  Pros and cons of both? Thanks 

[FfIghter23]

I would have a smartphone you have access to-- but I wouldn't rely on having everything on there to access. Many preceptors don't want you to be on phone very much because it looks bad to patients, even if you are looking up a few things.

 

I reduced everything to: Maxwells pocket reference, tarascons pharma, sanfords abx guide, and scut sheets from medfools (these are invaluable in inpatient settings).

 

If I needed anything else I would look it up on computer or phone on uptodate which my school provides free of charge. Medscape will work too.

[Timon]

Congrats on almost starting your Clinical Rotations!

 

A good place to start is this blog:

http://doseofpa.blogspot.com/2014/04/clinical-rotations-end-of-rotation-eor.html

 

I find it worth it to use questions banks and the ones I found that I liked the most were the Rosh Review and PANCE Master. I suggest using Rosh Review first, because it gives you some really good memory aids and gives better tutorials than other questions banks I've used. Here are the links to these two question banks:

 

Rosh Review:

https://app.roshreview.com/

 

PANCE Master

http://pancemaster.com/Student

 

 

I'm a fan of hard copy books. The ebooks are great if I want to reference something like Harrisons or CMDT, but those are some huge books to lug around. 

 

My favorite book that I've used the most and have successfully passed my PAEA EOR exams is "A Comprehensive Review For the Certification and Recertification Examinations for Physician Assistants Paperback," This book was developed with the PAEA and is broken down exactly as you would take an exam from the PANCE and the EOR exam blueprints.

http://www.amazon.com/Comprehensive-Certification-Recertification-Examinations-Assistants/dp/145119109X

 

The next book I've found that's been excellent and is small enough to carry in your white coat is Boards & Wards USMLE Step 2 & 3:

http://www.amazon.com/Boards-Wards-USMLE-Steps-Series/dp/1451144067

 

The other item I highly suggest you get is Tarascon Pocket Pharmacopoeia 2014 Deluxe Lab-Coat Edition. They have a more comprehensive book and I'm actually about to migrate from the pocket edition I'm currently carrying to the larger book just because it includes some details I'd prefer to reference at this stage into my rotations (currently 7 months completed).

http://www.amazon.com/Tarascon-Pocket-Pharmacopoeia-Lab-Coat-Edition/dp/1284026841

 

Another book that is very popular and is very compact to fit into your white coat is Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine (Pocket Notebook)

http://www.amazon.com/Pocket-Medicine-Massachusetts-Hospital-Handbook/dp/1451193785

 

Some apps that I found to be really useful has been 

- UpToDate (free access provided by my school)

- Epocrates

- Pedi Safe

- MedCalc

- Isabel (free access provided by my school)

- ToxToolBox

- WikiEM

- Radiopaedia

 

If you're taking the EOR from the PAEA, a strategy I've been using that many have adopted has been taking the topic lists for each exam and making a blank chart out of them and then filling in the following items (each one its own column): Most Common, Buzzwords, Hallmark Si/Sx, 1st Line vs Gold Standard Diagnostic Tests, 1st Line, 2nd Line and Gold Standards Treatments.

 

When studying for the exam, focus on the areas that have the higher percentage of weight for the exam. For example, for the EM EOR Exam the breakdown as to how many questions there will be is; Cardio  20%, Ortho 15%, Pulm 10%.... Hemeatology 4%. I'd spend my time focusing on the Cardio, Ortho and Pulm and maybe glance over the Heme section. Each EOR exam will have different subjects emphasized more than the other. For example, Surgery has 50% of that exam comprised of GI questions. 

[cinntsp]

AgileMD!

[gbrothers98]

>>If you're taking the EOR from the PAEA, a strategy I've been using that many have adopted has been taking the topic lists for each exam and making a blank chart out of them and then filling in the following items (each one its own column): Most Common, Buzzwords, Hallmark Si/Sx, 1st Line vs Gold Standard Diagnostic Tests, 1st Line, 2nd Line and Gold Standards Treatments.

 

When studying for the exam, focus on the areas that have the higher percentage of weight for the exam. For example, for the EM EOR Exam the breakdown as to how many questions there will be is; Cardio  20%, Ortho 15%, Pulm 10%.... Hemeatology 4%. I'd spend my time focusing on the Cardio, Ortho and Pulm and maybe glance over the Heme section. Each EOR exam will have different subjects emphasized more than the other. For example, Surgery has 50% of that exam comprised of GI questions. <<

 

Definitely have Tarascon available to you or ePocrates. 

One big question to answer on rotation is while you have this resource in your pocket, do you know how to use it?

I have had many students with a resource that when I asked them to look it up, they were at a loss how or where.

So know your resource and how to use it.

 

One last thing I would add to using a topic list and correlating with task areas.

A major part of these exams is a question where providing a diagnosis is an answer.

If all the blueprints are viewed, the diagnosis section actually has the most questions, always a minimum of 25, 1/4 of the exam!

Here is what is explained under the Core Tasks & Objectives for diagnosis:

 

• Select the most likely diagnosis based upon historical information, physical examination findings, and laboratory and diagnostic study findings.

If knowledgeable concerning the PANCE/PANRE, this is the formulate the most likely diagnosis task area.

Have to synthesize all those factoids listed above and come up with a coherent diagnosis.

 

Two ways to prepare for that:

1. Take a disease and answer the question what will my patient come to me complaining of?

2. Make an illness script, ie 55 y/o male, long standing etoh abuse, upper abdominal pain of acute onset, BS quiet, severe tenderness to upper abd on palpation, tachycardic, no fever, nl EKG & CXR, WBC 19k with a shift, Lipase 3000. All this = acute pancreatitis.

 

Good luck.

G Brothers PA-C

[SERENITY NOW]

Good recommendations above.  I am a big textbook/resource fanatic.  I've tried many resources and there definitely is a big range in quality.  I'd recommend you have high quality in the different types of resources you need.

 

For example, you'll need:

 

1 - A good review book for reference and studying for exams.  My favorite hands down is Pance Prep Pearls - http://www.amazon.com/Pance-Prep-Pearls-Dwayne-Williams/dp/1497396875/ref=sr_1_1?ie=UTF8&qid=1432516132&sr=8-1&keywords=pance+prep+pearls

This is the best one IMO.  It has all of the details you'll need to know with the pathognomic terms highlighted, comparisons between similar disease processes, and he does a really good job of summarizing the logic underlying everything so you really learn it and the things stick.  Check out the reviews, I am not the only one who loves this review book.

 

2 - A good podcast for your commuting times, geared towards the rotation specialty.  There are some great ones out there.  For emergency medicine, for example, you have to check out EMBasic by Steve Carrel.  He is fantastic - he goes through the clinical mindset as you approach each specific chief complaint.  Highly recommended.  For surgery there is Surgery101.  Also very good. 

 

3 - (If you have an iphone or ipad) - Some good medical apps.  My favorite, again for emergency medicine, is Resuscitation.  It is virtual case simulators to allow you to practice forming your ddx and making decisions independently.  I can't recommend this enough.  Well worth the 5$ per section - I've bought them all. 

 

4 - The case files series is really great for the most common issues in the specialty/rotation you are on.  Many people only studied these for EOR exams and did well.  These work well for EOR prep as well as practical prep for the rotation. 

 

Lots of other recommendations.  I could go on and on.  But the 4 above are hands down the best! 

 

The only other recommendation I'd make is "Problem Solving in Clinical Medicine" by Paul Cutler - http://www.amazon.com/Problem-Solving-Clinical-Medicine-Diagnosis/dp/0683301675 .

This was very helpful for me to transition from thinking didactically to clinically.  While it won't necessarily help with EOR exams, it is very helpful for clinical decision making. 

[winterallsummer]

Stethoscope, pen, agileMD and Medscape, scrap paper.  I have a separate post about what books I recommend if you care to search it.

 

Also huge bump to the above "Problem Solving in Clinical Medicine" - arguably the best piece of medical literature out there, bar none.  Do not worry that it is old, not much has changed and almost everything in that book still applies.  I read it during the end of my clinical year and it really helped tie everything in together.

 

Oh, and when on surgery or procedure heavy ED, it never hurts to carry some saline flushes, surgical tape, trauma shears, surgilube, 4x4's.

[CAAdmission]

Tarascon and Sanford guide. In paper. Forget all the fancypants electronic crap.

[Dynamo24]

Tarascon and Sanford guide. In paper. Forget all the fancypants electronic crap.

The Sanford app is MUCH easier to use than the book. I would recommend that to anyone. 

[xxx]

Thanks for all the tips so far. Im dying to get out of the classroom.  I ordered the "Problem Solving in Clinical Medicine" for like 40 cents.  I really like the podcast idea.  I have an hour commute plus gym time that I can listen.  Any other podcasts you guys would recommend?   

[Dynamo24]

Thanks for all the tips so far. Im dying to get out of the classroom.  I ordered the "Problem Solving in Clinical Medicine" for like 40 cents.  I really like the podcast idea.  I have an hour commute plus gym time that I can listen.  Any other podcasts you guys would recommend?   

 

EMCrit is the best emergency podcast out there. Its by Scott Weingart. Its pretty intense and covers a variety of topics. He does some deep dives on airway and sepsis. Check out EM:Rap Its a subscription based podcast (I think $110) but you get access to an incredible amount of information. They have a variety of guests that cover almost every topic you could want. ERCast by Rob Orman is really good, too. Check out Life In The Fast Lane. Its an EM blog but, again, it covers a multitude of topics that will be beneficial to you. Its also a great source for EKG practice. Get plugged into #FOAMed on twitter and just peruse that hash tag to find some nuggets here and there. Its a great movement for students and clinicians alike. Those suggestions should keep you busy for the next two years haha. 

 

I hear you about getting out of the classroom. Every day this last semester is like pulling teeth.